Since the Taliban seized power over Afghanistan in 2021 the rights of women have been increasingly restricted. Women have disappeared from the surface without freedom to move in public, to work, to get an education or to express their opinion. Especially the lack of female physicians leaves Afghan women without access to health care and vulnerable to serious health risks, such as PCOS and endometriosis.
Recently, a spokesperson for Afghanistan’s Ministry of Virtue, Saif Islam Khayber, has announced that women will soon be allowed to study and work again as part of a strict education plan. Under strict islamic rules this plan is supposed to be created because the country needs educated and working women.
The exclusion of women from education and work has multiple threatening consequences, especially for women who need to see a doctor. First, the prohibition for women to work leads to a shortage of practicing female physicians. Secondly, the ban on women to study hinders young female doctors from joining the profession. This suggests a serious shortage of skilled health care workers. However, the dilemma goes further. What remains are male doctors, who are not allowed to examine female patients. In addition, very limited financial autonomy, fear to go outside and travel distances to a possible clinic make it almost impossible to seek out a doctor. Humanitarian crises and poverty aggravate the situation. Consequently, women have no access to medical care. Life expectancy has decreased dramatically. According to the latest UN Women report, by 2026 child marriage and early childbearing are expected to increase by 45%, while maternal mortality is projected to rise by more than 50%.
However, not only pregnant women suffer from the disrupted healthcare system in Afghanistan. In Europe there is a huge patient group that remained invisible and ignored until receiving attention a few years ago. The discussion is about women with gynecological cystic diseases, like the Polycystic Ovary Syndrome (PCOS) or Endometriosis. These diseases are often tabooed, unknown or are only gradually receiving attention. In many countries, especially in low and middle-income countries, the general public as well as healthcare care workers do not know that chronic pelvic pain can be caused by several diseases and is often stigmatized. Furthermore, the number of young women who experience issues with reproductive organs is alarming.
Besides it is important to consider how sexual and reproductive health and rights, as well as quality of life can be affected. Around 20% of women develop ovarian cysts at some point in their lives. These are fluid- or tissue-filled sacs located on the ovaries. In Polycystic Ovary Syndrome (PCOS), multiple cysts can form on the ovaries. This condition affects up to 13% of women of reproductive age, with 70% remaining undiagnosed. Their formation is often due to a hormonal imbalance, and they may cause unbearable pain, menstrual irregularities, and mood swings. It can also lead to complications when becoming pregnant, which increases the pressure on women in some cultures. While this should be evaluated by a doctor, it is usually not dangerous. In some cases, a minimally invasive surgery is necessary to ensure blood supply to the ovaries and prevent necrosis. Lastly, endometriosis is a condition that affects around 190 million people worldwide—roughly 10% of women of reproductive age. Despite being so common, it remains undiagnosed in a large number of cases. Endometriosis is a chronic disease where tissue similar to the lining of the uterus grows outside the uterus. It can cause intense period pain, heavy bleeding and chronic pelvic pain. The pain remains after menstruation and includes symptoms such as bloating, nausea, pain during sex, bowel movements as well as urination. For many, endometriosis also affects mental health, contributing to anxiety and depression. Furthermore, between 25% and 50% of women suffer from infertility. And again, there is no cure, but only treatment on managing symptoms and improving quality of life. Treatment includes painkillers, hormone therapy, and in some cases, surgery to remove the problematic tissue.However, for women in low-income countries and especially in Afghanistan endometrioses causes unimaginable health risks and consequences. Examination, diagnosis and treatment are hard to access. Even where care is available, it often comes with high out-of-pocket costs. Moreover, all of these diseases go far beyond physical pain.They can affect relationships, education, careers, and mental health. They can lead to isolation or shame because society still stigmatizes chronic pelvic pain and dismisses its symptoms.
After the statement by Saif Islam Khayber, spokesperson for Afghanistan’s Ministry of Virtue, it remains to be seen whether women in Afghanistan will gain more rights or if the statement was merely intended to mislead the public. However, thousands of girls and women in Afghanistan suffer from endometriosis, PCOS and other diseases. Without access to examination, they often do not know their diagnosis and what causes the pain and other symptoms. Education and work permission for female doctors and other healthcare workers are needed urgently. For now, the situation for Afghan girls and women remains precarious and desperate with a frightening impact on their health and life expectancy.